Tertiary center referral delay of patients with dementia in Southern Brazil: associated factors and potential solutions

Abstract

ABSTRACT. Early dementia diagnosis has many benefits and is a priority. In Brazil, most cases are diagnosed by a specialist. Objective: We aimed to study the average time from disease onset to specialist assessment and related factors; we also propose potential strategies to deal with this delay. Methods: This was a cross-sectional database study in 245 patients with dementia from an outpatient clinic in a tertiary university hospital in Southern Brazil, which only assesses individuals from the Unified Health System (SUS). The outcome was time from symptoms onset to specialist assessment, reported by the informants. Individuals were separated into two groups: less and more than 1 year to specialist assessment. Multivariable analysis was used to test the potential related factors associated with delayed specialist assessment. Results: Mean±SD of time from symptoms onset to specialist assessment was 3.3±3.3 years. In the unadjusted analysis, individuals who were assessed before 1 year were more often diagnosed with vascular dementia, had more sudden and subacute onset, neuropsychiatric symptoms at presentation, rapid progression, and alcohol and antipsychotics use (p<0.05). In multivariate analysis, the effects of personality changes and onset presentation persisted, even when controlling for other variables. Conclusion: We found a long time from disease onset to specialist assessment, and those with personality changes and faster presentation were referred earlier. Improving the diagnostic capability of general practitioners, mass educational campaigns and transmission of knowledge by experts are some potential strategies to deal with delay of dementia diagnosis.

Disparity in the use of Alzheimer's disease treatment in Southern Brazil

“…In addition, most of the patients had moderate dementia (CDR = 2). Although we know that patients with dementia usually have a diagnostic delay in Brazil 29 , we could not assess whether this delay was associated with our results. We also found 3 patients with CDR = 0 receiving AD medication.…”

Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil

“…These findings, which mimic our own, may indicate that specialized referral protocols in the Brazilian SUS require prompt revision to lessen the burden on secondary and tertiary services and reduce delays in patient care. ( 27 , 28 )…”